Provider Demographics
NPI:1316159817
Name:MEYER, ELIZABETH STANSBROUGH (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:STANSBROUGH
Last Name:MEYER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:MARY
Other - Last Name:STANSBROUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1360 SOUTH FIFTH
Mailing Address - Street 2:STE 208
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2446
Mailing Address - Country:US
Mailing Address - Phone:636-947-4924
Mailing Address - Fax:636-947-5971
Practice Address - Street 1:1360 SOUTH FIFTH
Practice Address - Street 2:STE 208
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2446
Practice Address - Country:US
Practice Address - Phone:636-947-4924
Practice Address - Fax:636-947-5971
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO137851223G0001X
MO0137851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice